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General NPI Number Information
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NPI Number | 1013995323
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Entity Type | Individual
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Provider Name | KENNETH LEVI MOORE III CNP
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Gender | Male
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 101 E ALEX BELL RD STE 190
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City | DAYTON
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State | OH
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Zip | 45459-2752
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Country | US
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Telephone | 937-425-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 415 BYERS RD STE 300
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City | MIAMISBURG
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State | OH
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Zip | 45342-3684
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Country | US
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Telephone | 937-866-2494
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Fax | 937-866-8494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 273520
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License Number State | OH
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